Healthcare Provider Details

I. General information

NPI: 1386591261
Provider Name (Legal Business Name): CARLY DIMENNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CARLY NEVINSKI

II. Dates (important events)

Enumeration Date: 03/11/2026
Last Update Date: 05/27/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

141 N FORGE ST
AKRON OH
44304-1407
US

IV. Provider business mailing address

2793 OTTER DR
COVENTRY TOWNSHIP OH
44319-1831
US

V. Phone/Fax

Practice location:
  • Phone: 330-375-3000
  • Fax:
Mailing address:
  • Phone: 330-903-1190
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number158728
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: